Nonsurgical and Surgical Treatments for Lumbar Spinal Stenosis.

[Argirios Argiriou]

May 19, 2015

Paul S. Mueller, MD, MPH, FACP reviewing Delitto A et al. Ann Intern Med 2015 Apr 7. Nerland US et al. BMJ 2015 Apr 1.

Physical therapy and minimally invasive surgery both fared well in randomized trials against open surgery.

Two recent studies shed light on options for treating patients with lumbar spinal stenosis.

In a randomized trial, investigators compared surgical decompression versus a formal physical therapy (PT) program in 169 patients with lumbar spinal stenosis and neurogenic claudication; all patients were considered candidates for surgical decompression and had consented to surgery. Intent-to-treat and sensitivity analyses revealed no significant differences in physical function (primary outcome) or in pain, disability, symptoms, or expectations (secondary outcomes) between the surgery and PT groups at any point during 2-year follow-up. Although 57% of patients assigned to PT crossed over to surgery during follow-up, the researchers state that statistical techniques show the equivalence of PT and surgery.

In a multicenter, observational study, investigators used data on 885 patients from a spine surgery registry to compare the effectiveness of microdecompression versus open laminectomy in patients with lumbar spinal stenosis. About 70% of patients in each group experienced clinically meaningful improvement in disability. To minimize confounding, propensity-matched cohorts were used for statistical analyses. Microdecompression and laminectomy were equally effective for preventing disability, and no differences between groups were observed for length of surgery, perioperative complications, or quality of life. Unsurprisingly, length of hospitalization was significantly shorter in the microdecompression group.

COMMENT

The results of these two studies provide guidance for patients with lumbar spinal stenosis and their clinicians. PT might be a reasonable initial option for patients with symptomatic lumbar spinal stenosis who are being considered for surgery. For patients who do undergo surgery, microdecompression might be a better option than open laminectomy.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication
Consultant / advisory boardBoston Scientific (Patient Safety Advisory Board)
Editorial boardsMedical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor)
Leadership positions in professional societiesAmerican Osler Society (Vice President)

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